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What Does Low TSH Level In A Hashimoto's Thyroid Patient Indicate?

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Posted on Mon, 23 Jun 2014
Question: I was diagnosed with Hashimotos disease 9 years ago. I was taking Levoxyl (100 mg) for 7 years without any problems. Two years ago my body rejected the Levoxyl. I was put on Armour Thyroid 90mg. When I started Armour Thyroid I lost a needed 20 pounds, and felt better. Then because of what my blood test showed my doctor kept increasing the Armour Thyroid up to 180mg. I gradually started gaining weight, and my TSH became inexistent. I gradually gained 30 pounds over this time. Then another doctor changed me to 112 mg of Synthroid. I was on Synthroid of 8 weeks, but I kept gaining more weight. I am back to 90 mg Armour Thyroid, and even though I have not gained weight, I can't lose it either. I am always filled up with water not matter how much I diet and exercise. I am extremely uncomfortable with all this water. Nothing seems to help. I'm not sure it is due to my thyroid anymore. Is there anything else that can be causing this problem? I had all kinds of bloodworm done in April, and everything was normal. My TSH was starting to come up.
I mean my TSH became nonexistent, NOT inconsistent. It was .009, on 180 mg Armour Thryroid. My t4 and t3 were in the normal range at that point, (January 2014.)
doctor
Answered by Dr. Shehzad Topiwala (6 hours later)
Brief Answer:
Thyroid

Detailed Answer:
I have noted your thyroid history. From an endocrine standpoint, the experimenting you have done with dosing and choice of medication is unsafe for your body.

Lets address 2 things.

1) I see you were diagnosed with Hashimotos disease. But do you recall your highest TSH value ever? I am asking this question because sometimes a person can have Hashimotos and not necessarily need thyroid medication until the TSH rises above normal ie (s)he becomes truly hypothyroid

2) Armor is not recommended by thyroid experts for the treatment of hypothyroidism. This was reinforced in the most recent XXXXXXX Thyroid Association guidelines. Levothyroxine alone is sufficient. Synthroid is one brand name for levo thyroxine.
Armor is deemed unsafe too.
Appropriate dosing with synthroid to target the TSH in the range of 0.4 to 2.5 with free T4 in the higher range of normal is generally the accepted goal. Exceptions where conservative dosing is used are heart and bone problems.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (27 minutes later)
I'm not sure what my highest TSH level was. It was an Endocrinologist from XXXXXXX Presbyterian in NY that put me on Armour Thryroid. As I mentioned previously, I believe my body rejected Levoxyl, 2 years ago, after taking it for 7 years (100mg.) Every doctor I ever went to which was at least 6 or 7, agreed, I needed to be on the medication, because they all said my body produces very little thyroid hormone.

Two years ago, I went into a severe depression, my voice became horse, and I gained 5 pounds. that is when they changed me to the Armour. I know Levoxyl is just like Synthroid. I just don't think Synthroid is for me. My eyes always swelled up on Levoxyl, and they did the same when I recently went on Synthroid for 8 weeks. I know Armour is not the Standard, because the Endocrinologist I just went to in February said they only give Synthroid in her office. It is my own Primary Care doctor who writes me the prescriptions for Armour.

The Endocrinologist I went to said I did not give myself long enough on the Synthroid (i was on 8 weeks,) to know if it would work for me or not. All I know is my eyes swelled up and I gained another 8 pounds when I was recently taking the Synthroid. the doctor said my correct dose for Synthroid was 112 mg. My weight has stabilized in the 6 weeks I am taking the Armour, but I cannot lose.My eyes are no longer swollen. I know for a fact this is water weight. I am retaining water no matter how much or how little water I drink. Last year I stopped taking all medications for a few months. I did lose weight, but my hair started falling out, and i totally lost my focus in everything I did in my life, and my life started getting out of control. So I believe I need medication. I don't know which one or how much.
doctor
Answered by Dr. Shehzad Topiwala (9 hours later)
Brief Answer:
Follow up

Detailed Answer:
I suggest you seek another cause for the water retention and weight matters from your family doctor/internist , while stabilizing the thyroid with levothyroxine alone under the care of an endocrinologist
There can be various reasons for weight gain like heart, liver and kidney conditions which the general/family doctor can look into.
There are some rare causes of weight gain such as Acromegaly and Cushing's syndrome which can be tested for as per the provider's discretion.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala (9 hours later)
I do have an appointment with my Cardiologist/Internist next week, and I will ask him to try to diagnose the reason for this water retention. I agree, that it might not be related to my thyroid at this point.

My additional question to you is: Why is Armour Thyroid considered a dangerous drug? I called the manufacturer yesterday and they said they stand behind their product. My pharmacy says it flies off their shelf, and they always need to order it. Why is it FDA approved if it is a dangerous drug? Why isn't it being pulled off pharmacy shelves. Finally, and most importantly, it seems to relieve my symptoms much better than Synthroid. I need more specific reasons for why it may be dangerous to my health, before I stop taking it. I do not see how only one medication (Synthroid) can possibly be good for everyone, since no two people are alike.
doctor
Answered by Dr. Shehzad Topiwala (40 minutes later)
Brief Answer:
Second follow up

Detailed Answer:
People who have hypothyroidism must take a pill containing synthetic thyroid hormone every day to replace the thyroid hormone they lack. Synthetic T4 is the best medicine for hypothyroidism because it works the same way as your own thyroid hormone.
Levothyroxine is the preferred way to replace thyroid hormone. Two other options are considered for some patients, but have disadvantages:
1 “Natural” hormones made from the dried thyroids of pigs or cows. Dried animal thyroid can help replace the missing hormone but is seldom prescribed nowadays. It's balance of T3 and T4 is different from human thyroid hormone.
2 In addition, different batches of animal thyroid can have different amounts of T3 and T4, which can affect a patient’s health. Experts agree that synthetic thyroid hormone is safer than animal thyroid.

Armor is a type of animal thyroid
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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What Does Low TSH Level In A Hashimoto's Thyroid Patient Indicate?

Brief Answer: Thyroid Detailed Answer: I have noted your thyroid history. From an endocrine standpoint, the experimenting you have done with dosing and choice of medication is unsafe for your body. Lets address 2 things. 1) I see you were diagnosed with Hashimotos disease. But do you recall your highest TSH value ever? I am asking this question because sometimes a person can have Hashimotos and not necessarily need thyroid medication until the TSH rises above normal ie (s)he becomes truly hypothyroid 2) Armor is not recommended by thyroid experts for the treatment of hypothyroidism. This was reinforced in the most recent XXXXXXX Thyroid Association guidelines. Levothyroxine alone is sufficient. Synthroid is one brand name for levo thyroxine. Armor is deemed unsafe too. Appropriate dosing with synthroid to target the TSH in the range of 0.4 to 2.5 with free T4 in the higher range of normal is generally the accepted goal. Exceptions where conservative dosing is used are heart and bone problems.